Pain, Pattern and Polytrauma – Predictors of Sexual Dysfunction in Pelvic Fractures: A Retrospective Multicenter Analysis

Document Type : RESEARCH PAPER


1 Alrazi Orthopedic Hospital, Alsabah medical region, Kuwait

2 Jaber Alahmed Alsabah Hospital, South Surra, Kuwait

3 Farwaniya Hospital, Farwaniya Governorate, Kuwait

4 Alsalam International Hospital, Bneid Al Gar, Kuwait


Objectives: In the local and cultural setting of high trauma rates and a reserved outlook on sexual 
function, this study examines the incidence and underlying factors of sexual dysfunction (SD) following 
pelvic fractures.
Methods: A Multi-center retrospective cohort analysis performed in two general hospitals and one tertiary orthopedic 
center with collection between 2017 and 2019. Consecutive patients with pelvic fractures between January 2017 
and February 2019 were followed up at 18-24 months to screen for new-onset SD using the International Index of 
Erectile Function-5 (IIEF-5) and Female-Sexual-Function-Index-6 (FSFI-6). Additional variables include age, sex, 
Young-Burgess classification, urogenital injury, injury severity score, persisting pain, sacroiliac disruption, 
intervention and if sexual health was discussed or patient referred for sexual healthcare.
Results: One-hundred and sixty-five patients (n = 165) were included, (83%) male, (16%) female with a mean age 
of 35.1 years (Range 18-55). Fracture patterns included lateral compression (LC) (51.5%), anteroposterior 
compression (APC) (27.7%), and vertical shear (VS) (20.6%). The urogenital injury occurred in 10.3%. The mean 
IIEF-5 and FSFI-6 scores were 20.8 and 24.7 in males and females, respectively. A total of 40 males (29%) scored 
below the 21 cut-off scores for SD, while only one female (3.7%) scored below the corresponding score of 19. Of all 
participants reporting sexual dysfunction, 56% discussed sexual health with their providers, while 46% of these 
patients were referred for further management. Significant predictive factors for SD using a multivariate logistic 
regression model include increasing age (OR-1.093, p = 0.006), APC III (OR 88.887, p = 0.006), VS (OR-15.607, p 
= 0.020), persisting pain (OR 3.600, p = 0.021) and increasing injury severity score (OR 1.184, p <0.001).
Conclusion: SD is common among pelvic fractures, and risk factors include APC or VS type fractures, increasing 
age, increasing injury severity score, and persisting pain. Providers should ensure patients are screened for SD and 
referred appropriately as patients may not willingly disclose underlying symptoms.
 Level of evidence: III 


Main Subjects

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